Recommendations on Complementary Food Introduction Among Pediatric Practitioners

Question Is it appropriate for pediatric practitioners to recommend waiting several days between the introduction of new foods considering the current emphasis on incorporating a wide variety of foods during infancy to prevent food allergy development? Findings In this survey study of 563 pediatric practitioners, 217 (39%) recommended waiting 3 days or longer before introducing new foods; however, for infants at risk for developing food allergy, 259 (66%) recommended waiting. Although 264 practitioners (47%) recommended that cereal be introduced first, 226 (40%) did not recommend any specific order during food introduction. Meaning This study found that there was variability among pediatric practitioners' recommendations on infant diet, suggesting that a reevaluation of published guidelines may be warranted. Importance The American Academy of Pediatrics and the Centers for Disease Control and Prevention recommend waiting 3 to 5 days between the introduction of new complementary foods (solid foods introduced to infants <12 months of age), yet with advances in the understanding of infant food diversity, the guidance that pediatric practitioners are providing to parents is unclear. Objective To characterize pediatric practitioner recommendations regarding complementary food introduction and waiting periods between introducing new foods. Design, Setting, and Participants In this survey study, a 23-item electronic survey on complementary food introduction among infants was administered to pediatric health care professionals from February 1 to April 30, 2019. Responses were described among the total sample and compared among subgroups. Survey invitations were emailed to 2215 members of the Illinois Chapter of the American Academy of Pediatrics and the national American Academy of Pediatrics' Council on Early Childhood. Participants were required to be primary medical practitioners, such as physicians, resident physicians, or nurse practitioners, providing pediatric care to infants 12 months or younger. Main Outcomes and Measures The main outcome measures were recommendations on age of complementary food introduction and waiting periods between the introduction of new foods. Categorical survey items were reported as numbers (percentages) and 95% CIs. Means (SDs) were used to describe continuous survey items. Results The survey was sent to 2215 practitioners and completed by 604 (response rate, 27.3%). Of these respondents, 41 were excluded because they did not provide care for infants or pediatric patients. The final analyses included responses from 563 surveys. Of these, 454 pediatricians (80.6%), 85 resident physicians (15.1%), and 20 nurse practitioners (3.6%) completed the survey. Only 217 practitioners (38.6%; 95% CI, 34.1%-44.6%) recommended waiting 3 days or longer between food introduction; 259 practitioners (66.3%; 95% CI, 61.4%-70.8%) recommended waiting that amount of time for infants at risk for food allergy development (P = .02). A total of 264 practitioners (46.9%; 95% CI, 42.8%-51.0%) recommended infant cereal as the first food, and 226 practitioners (40.1%; 95% CI, 36.1%-44.2%) did not recommend a specific order. A total of 268 practitioners (47.6%; 95% CI, 43.5%-51.7%) recommended food introduction at 6 months for exclusively breastfed (EBF) infants, and 193 (34.3%; 95% CI, 30.5%-38.3%) recommended food introduction at 6 months for non-EBF infants (P < .001); 179 practitioners (31.8%; 95% CI, 28.1%-35.8%) recommended food introduction at 4 months for EBF infants, and 239 practitioners (42.5%; 95% CI, 38.4%-46.6%) recommended food introduction at 4 months for non-EBF infants (P < .001). A need for additional training on complementary food introduction was reported by 310 practitioners (55.1%; 95% CI, 50.9%-59.1%). Conclusions and Relevance In this survey study, most pediatric practitioners did not counsel families to wait 3 days or longer between introducing foods unless infants were at risk for food allergy development. The findings suggest that the current recommendation limits infant food diversity and may delay early peanut introduction. Because the approach to food allergy prevention has changed, a reevaluation of published feeding guidelines may be necessary. This survey study characterizes pediatric practitioner recommendations regarding complementary food introduction and waiting periods between the introduction of new foods.